Caught Between Conscience and Compulsion - Understanding Scrupulosity, OCD, and Religious Trauma

by Mx. Lauren Johnson

---

What if your moral compass— once a source of comfort and guidance— has become a relentless source of fear, shame, and self-doubt? Obsessive-Compulsive Disorder (OCD) is a mental health disability marked by recurrent, intrusive, distressing thoughts (obsessional doubts), coming from “what ifs” (imagined possibilities), which then override reality, leading to repetitive behaviors or mental rituals (compulsions).

While compulsions are intended to reduce anxiety and bring you relief, they inevitably intensify your distress, because you have mistaken an imagined possibility for present reality. It should be no surprise that according to the World Health Organization (2001), OCD is among the top ten most disabling medical and mental health conditions worldwide.

One of the most painful aspects of OCD is its tendency to attach itself to what you value most. For many, this means moral and religious beliefs become targets— also known as scrupulosity OCD. This can be especially devastating for those who are LGBTQIA+, neurodivergent, or carrying the weight of religious trauma from controlling, punitive, or spiritually abusive environments.

Hi, I’m Mx. Lauren Johnson (he/him), a therapist specializing in OCD, C-PTSD, and AuDHD. My approach is shaped by both clinical training and lived experience, including my own journey navigating OCD, religious trauma, and neurodivergence. I’m passionate about creating spaces where you can untangle fear and shame while honoring every part of who you are— even the messy parts.

This blog post explores the intersection of OCD, namely scrupulosity OCD, and religious trauma, offering a foundation for understanding these struggles. For practical tools, visit the Neuroqueering Counseling site for the follow-up blog post: Navigating OCD and Religious Trauma with Trauma-Informed I-CBT and ACT.

Understanding Scrupulosity:

What It Looks Like

OCD is often misunderstood as perfectionism or being “extra careful.” In reality, it’s a disorder of doubt, anxiety, and imagined possibilities— sometimes called “the doubt disorder.” When OCD latches onto moral or religious themes, it’s called scrupulosity.

Scrupulosity involves a persistent preoccupation with being morally pure, good, or sinless. It fuels cycles of guilt, shame, and compulsions. Even when you know your fears are irrational, they can still feel very real, overwhelming, exhausting, and isolating.

What does this look like?

Scrupulosity may lead you to replaying conversations or memories to check for wrongdoing, fearing blasphemy or moral failure, ruminating on if you’ve committed the “unforgivable sin,” confessing the same mistakes repeatedly, or performing rituals like prayer until they feel “just right.” Importantly, moral scrupulosity is not limited to religious people. Individuals who are secular, spiritual-but-not-religious, or who have left religion can still experience OCD targeting your moral compass. You may feel consumed by questions like, “Did I unintentionally harm someone?” or “Was I perfectly ethical in that choice?” These behaviors offer only temporary relief before doubt quickly resurfaces— often stronger than before.

A key truth to remember: OCD targets what matters most to you. It doesn’t define your character. Instead, it twists your integrity, compassion, and deeply held values into sources of fear. Recognizing this pattern is the first step toward separating your OCD from your moral or spiritual identity. This is especially important for those who have experienced religious trauma, societal marginalization, or challenges related to being neurodivergent.

If scrupulosity OCD alone feels heavy, religious trauma adds another layer of complexity— let’s explore how.

How Religious Trauma Makes Scrupulosity OCD Worse

While scrupulosity explains what it looks like, religious trauma helps explain why

it feels so intense and lasting.

Religious trauma refers to psychological harm from spiritual environments that are controlling, punitive, or abusive. By using fear, guilt, and self-doubt as core strategies for “spiritual safety,” these environments often teach you that safety depends on certainty— absolute clarity about morality, belief, and behavior. Even if you’ve left your religious tradition or no longer hold the same beliefs, the trauma can remain embodied, and OCD thrives on the uncertainty that it leaves behind, reshaping ordinary doubts into relentless obsessions. Religious trauma conditions you to survive through vigilance, and OCD magnifies that vigilance into obsessions and compulsions, trapping you in cycles of fear that feel inescapable.

Here’s how religious trauma amplifies scrupulosity and OCD:

• It creates fertile ground for fear. Teachings about hell, sin, or divine punishment can echo in the mind long after belief fades, feeding obsessional worries.

  
  

• It fuels shame. Purity culture, repression, and condemnation attach shame to natural thoughts and desires, making intrusive sexual or aggressive thoughts even more distressing.

  
  

• It undermines self-trust. High-control religious communities encourage obedience over autonomy, leaving you doubting your own judgment and prone to compulsive checking.

  
  

• It compounds marginalization. For LGBTQIA+ people, the rejection and shaming from religious trauma amplify OCD’s lie that you are “not good enough” or “sinful” just for being your authentic self.

Understanding this interplay is essential for reclaiming your agency and healing;

next we’ll explore what healing at that intersection can look like.

Healing at the Intersection of OCD and Religious Trauma

Recovering from OCD and religious trauma requires more than symptom relief— it means seeing through OCD’s faulty stories, letting go of the feared possible self, and living from your authentic values rather than fear (Aardema, 2024).

Recovering from OCD and religious trauma also involves:

• Untangling fear-based messages ingrained by religious trauma.

  
  

• Reconnecting with reality in the present moment and dismissing

  imagined possibilities as false alarms, not genuine threats.

  
  

• Rebuilding trust in yourself and your decision-making abilities.

  
  

• Creating a sense of safety in mind, body, and beliefs— whether or not spirituality remains a part of your life.

  
  

You are not broken for struggling. With compassion and evidence-based therapies like Inference-Based Cognitive Behavioral Therapy (I-CBT) and Acceptance and Commitment Therapy (ACT), it is possible to rebuild trust in your real, authentic self, establish personal autonomy, reclaim your values, and build a sense of peace and confidence — inside or outside of any religious framework.

I know these struggles not only as a therapist, but also as someone who has walked this road myself.

A Brief Note from Lived Experience

While this blog post centers broader experiences of scrupulosity, OCD, and religious trauma, it’s also informed in part by my own story. I was raised in evangelical Christianity, and after years of religious indoctrination, I attended Liberty University. After deconstructing my spiritual identity, I discovered my real, authentic self and accepted myself as a queer, trans person— redefining my spirituality on my own terms.

As a young child and teenager, I experienced doubts about who I was and how I showed up in the world. I feared doing unintentional harm and lacking self-awareness. As an adult, these fears intensified, and the thoughts became relentless. While it was initially overwhelming, finding the words to describe my experience — and understanding that it was OCD— was both enlightening and validating.

Living with OCD alongside religious trauma showed me how religious teachings meant to protect can intensify shame, obsessions, and compulsions. In my experience, religious trauma planted seeds of self-doubt, which were nourished and reinforced by life stressors, and ultimately, I experienced a sudden loss that caused my OCD to flourish and bloom. Religious trauma impacted my OCD by making me worry that to my core, I was a deceitful, harmful, careless person, and I shouldn’t trust myself. I learned that my feared possible self was only blocking me from seeing who I truly was; recognizing this opened the way for my real, authentic self to take center stage. What once felt like an unbearable burden of fear and shame has transformed into resilience, self-trust, and purpose— the same foundation I now offer others on their own healing journey.

As a queer, trans, neurodivergent person, I also know firsthand how these struggles compound when layered with identity-based trauma— whether from being LGBTQIA+ in religious spaces, growing up Autistic and/or ADHD in environments that demanded conformity and neuronormativity, or navigating both. Because I know how isolating all of this can feel, I am deeply committed to supporting others who are navigating similar paths by providing secular, trauma-informed, affirming therapy, including I-CBT and ACT.

And yet, lived experience is only part of the picture— let’s look at what moving forward can mean for you.

Moving Forward

Religious trauma amplifies OCD by sowing doubt, as shown in scrupulosity. Those obsessional doubts drag you into imagined dangers, but recovery means stepping back into reality and living from who you truly are— not as OCD or trauma would define you.

It’s not about eliminating every intrusive thought; after all, intrusive thoughts are part of being human, as research shows that 93.6% of people experience them (Radomsky et al., 2014). Healing from OCD and religious trauma means learning to see obsessional doubts as false, loosening OCD’s grip, and building a life grounded in authenticity, safety, and personal values. Ultimately, recovery is about rebuilding trust in yourself.

Therapy that integrates evidence-based care with trauma informed support can help you:

• Recognize how OCD hijacks your values and twists them into fear.

  
  

• Distinguish between your feared possible self and your authentic self (a

  concept from I-CBT).

  
  

• Practice self-compassion, grounding, and nervous system regulation.

  
  

• Reclaim agency and choice over your actions and beliefs.

You are not defined by OCD or religious trauma. Your story is valid. Your healing is possible.

Wherever you are on your journey— deconstructing faith, reclaiming spirituality, or finding peace outside of religion— you deserve care that honors every part of who you are. Healing from scrupulosity, OCD, and religious trauma takes courage, but you don’t have to do it alone.

What might shift for you if your values guided your healing, instead of fear?

For practical strategies to navigate OCD and religious trauma, check out Lauren’s follow up blog post: Navigating OCD and Religious Trauma with Trauma-Informed I-CBT and ACT.

---

This guest blog post was written by Mx. Lauren Johnson (he/him), a queer, trans, neurodivergent therapist and owner of Neuroqueering Counseling Services, LLC, serving online in Lynchburg, VA and across VA, NC, SC, FL, and VT. Lauren specializes in supporting adults and teens 16+ with OCD, C-PTSD, and AuDHD through a deeply affirming and trauma-informed approach. Learn more about his work or connect with him at Neuroqueering Counseling Services.

Paths Uncharted is the blog of Divergent Path Wellness, a Charlottesville-based practice offering affirming, neurodiversity-friendly therapy for unconventional humans. We welcome guest contributors whose stories intersect with our values of inclusion, compassion, and authenticity. To learn more about our team and services, visit divergentpathwellness.com.